Case Study - Page 3

Because Sarah had responded so strongly to the slip of paper and how I’d handled it, I thought it might be useful to work directly with that at this stage as another way of reducing her fear. “Now I’d like you to play with the words that you wrote on that piece of paper. Just now, in your mind, you were able to ‘diss’ that doctor with ease. So you do indeed have ‘diss’ ease.”

As Sarah smiled broadly at this reframe, I went on to say, “I’d like you to do something similar with that longer word; find some other meaning in it, perhaps by saying it with a foreign accent, dividing the word up, or some play on words.” Sarah laughed and said, “I don’t know where this came from, but I came up with the word intercourse!” This was yet another nice contribution from her unconscious—later she said that, to her, intercourse meant conception and life, the opposite of the “death sentence.” It really didn’t matter what alternate meaning she came up with for the word interstitial. Any response would give her something else to think of automatically and unconsciously—an alternative response to the same stimulus.

This new response provided an experiential basis for choice, because now she could think of the old meaning, the new meaning, or both. Since the new meaning is much more enjoyable, Sarah was more likely to choose it, and this would dilute or diffuse the word’s threatening meaning. The fact that she came up with something that made her laugh was a bonus, because, as brain science has shown, a pleasant feeling adds emotional charge and makes it easier to remember what elicited the feeling.

Then I returned to the theme of learning more about her lung condition so she could use whatever information she found. I asked her to close her eyes and imagine going online to search for more information. I had two reasons for making this suggestion: I knew that the more information she had, the less fearful she’d feel, and I wanted her to have the information so she could take whatever actions might be indicated to preserve her health. This is an example of the importance of sequence when working with a problem. Sarah had been too afraid to think about finding out more about her health problem for two years. By taking the time in our session to reduce the fear by diminishing the certainty sustaining it, it became something we didn’t need to struggle over. Once the fear was reduced, we could begin to talk about searching for more information.

Knowing that curiosity is the opposite of fear as well as the best impetus for research and learning, I asked her to think of situations in which she’d felt curious, and gave her an example of my own. Some time ago, I’d wondered how the interior rearview mirrors in cars work when you flip them down to reduce headlight glare at night. I told her that after puzzling about those mirrors for a few months, I finally took one apart so I could understand it. Sarah found it amusing that I’d done that, both because it wasn’t something she’d have done, and because she was fascinated by how other people figure things out.

Some might think that the important aspect of my stories is that they’re personal disclosures used to build relationship; however, I think of them differently: I choose stories that I hope will elicit a spontaneous and memorable unconscious understanding. Making the stories personal adds to their reality, and I choose stories that I can act out, so they become part of the present moment, not a musty tale of what happened in a distant time and place.

For instance, when talking about the car mirror, I imagined being in the driver’s seat, and I reached out with my right hand to adjust the mirror, and I later gestured differently when I talked about taking it apart. When I use stories that aren’t personal, I still bring them into the moment by identifying with the protagonist and putting myself into the situation described, so that my natural nonverbal actions amplify the story’s impact.

By this point in our conversation, Sarah clearly had experienced a number of changes in her reaction to the “death sentence”; however, I didn’t know whether she could feel comfortable about researching information related to the lung disease. So, using the piece of paper and the words it contained as test stimuli to determine whether her fear had decreased sufficiently, I held up the paper, still folded, and asked Sarah if she was ready to take a look at the writing inside. She seemed hesitant, though no longer terrified, and said she wasn’t ready for that yet—which told me we needed to do more work.

I then reviewed some of the themes that I’d already mentioned, and amplified them with additional examples of the value of getting as much information as possible to make informed choices, so she could cope with the lung disease or whatever other difficulties life might present. I also reviewed the value of curiosity in searching for information and alleviating fear.

After a while, Sarah said, in a voice that was calm and bit surprised, “Oh, that’s interesting. That image of my lungs is down here now,” and she gestured about waist level and three feet to her right. Both her tone of voice and the change in location of the image of her lungs were spontaneous unconscious changes that indicated that she now had a significantly different response to the threat posed by the image: it was no longer “in her face.”

A little later she said, “You know, those words are just letters of the alphabet”—and I chimed in, “and out of order, too, just squiggles on paper.” When she said in a relaxed and grounded tone of voice, “I’m ready to look at those words now,” I handed her the note to read. She read it, and then folded the paper and tore it into small pieces. I said it was fine to tear up the paper, as long as she was committed to searching for information about the words on it and what they really meant. She calmly said that she was willing to do that, and her nonverbal expression was congruent with her statement. The note, the image of her lungs, and all they referred to no longer terrified her. Her condition was now only something that she needed to learn more about, so we ended the session.

Follow-Up

A month later, Sarah e-mailed me, “That was one heck of a session! I’ve looked up the condition and it seems so small to me. I think of it only occasionally. In the articles I read on the web, it became boring.”

Three months later, she e-mailed me again, “I’ve since found out that a medication I take for high blood pressure has a side effect of a slight dry cough! I think of that experience only on occasion now, and sort of shrug my shoulders.”

After our session I looked up interstitial lung disease and found that it’s a general term for any kind of scarring of lung tissue, with a wide variety of causes and outcomes. Little is known about it, and there’s no known cure, other than the palliative treatment of symptoms. Since Sarah is symptom-free, there’s no useful action she can take in regard to the disease, so her thinking of it as small and boring and “shrugging it off” is completely appropriate. After she read the final version of this article, she said, “It all looks great to me,” and added that now the image of her lungs is “down by my right knee”—further confirmation that the changes we made together continue to be useful.

What elegant, skilled work! I especially appreciate the step-by-step explanation and rationale for each strategy used; so useful for us learners out there. You are a great
ego-free teacher. Thank you for ministering to Sarah!

Would it not have been simpler and much more straightforward for the client to realise that it's all just a story, just thoughts, and there's nothing to it?

Thoughts, both positive and negative, pop up automatically, but whether they are positive or negative, you save a lot of time, effort, energy and stress when you realise that they are just thoughts, stories, fantasies, and not true. They are just made up.

And that there is no need to replace negative thoughts with positive thoughts, 'cos they are made up too!

Just realise that they are thoughts, and leave it at that.

Job done!

Apply this to your life and your practice and life will be much simpler, happier and stresss free.

What an elegant way to shift perception and therefore the client's reality. I appreciated the reminder form John Grinder also. Being congruent is a wonderful way check on client progress and calibrate the change process itself. Thank you, Steve!